GAVI Support for Cholera Vaccine Could Have Far Reaching Benefits

David A. Sack, MD

Professor | Johns Hopkins Bloomberg School of Public Health
GAVI Alliance

The November 22, 2013 GAVI decision to commit funds to the stockpile of oral cholera vaccines (OCVs) is a huge step in the eventual control of this disease, which infects 2-3 million persons each year and kills over 100,000.

In 2010, the World Health Organization (WHO) revised its policy regarding the cholera vaccine and now recommends that it be used for countries with cholera and for areas at risk. In 2013, the WHO established a stockpile of 2 million OCV doses to be used in emergency situations. With its most recent announcement, GAVI has committed to increasing the size of the stockpile to make this vaccine more available and affordable to the poor countries which really need it. Although there is still not enough vaccine available to support the inclusion of the vaccine in integrated cholera control programs, this is a major step toward the eventual control of cholera.

Prior to this announcement by GAVI, manufacturers produced only small amounts of OCVs because they were not certain if there would be a demand.  With such small inventories, there was never enough of the vaccine for emergencies, such as the recent cholera outbreak in Haiti. Public health officials, seeing this shortage, would then not place vaccine orders, creating a vicious cycle of low supply leading to low demand. GAVI’s decision will hopefully interrupt this cycle by addressing the issue of low supply, which should then generate more demand; ultimately this will support the effective introduction of the vaccine into integrated cholera control programs.

Having a vaccine available is only one part of the cholera control effort, but it is a critical one. In addition increased immunization with the cholera vaccine, we can anticipate that the greater availability of the vaccine will have several additional benefits:

  • Increased stock of vaccine should encourage countries to improve their cholera surveillance so they know when and where to use the vaccine.
  • Improved cholera surveillance should improve reporting of cholera cases.
  • Improved cholera surveillance will facilitate better and timelier cholera case management, which can result in lower case fatality rates.
  • Increased cholera surveillance should also stimulate targeted improvements in water and sanitation by highlighting areas most at risk for this waterborne disease.
  • As countries improve their understanding of cholera risk, they can develop comprehensive control plans which will begin to “shrink the cholera map” in their countries.

In summary, this safe and effective vaccine, at a cost of $1.85 per dose, may do much more than protect the persons who take it. It may also help stimulate a range of activities that come together under an improved and integrated cholera control strategy, bringing the world one step closer to the control of cholera.

Learn more about the OCV stockpile, including guidance on how to access the stockpile.